Management of Persistent, Post-adenotonsillectomy Obstructive Sleep Apnea in Children: An Official American Thoracic Society Clinical Practice Guideline.

Background: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Although adenotonsillectomy is first-line management for pediatric OSA, up to 40% of children may have persistent OSA. This document provides an evidence-based clinical practice guideline on the management of children with persistent OSA. The target audience is clinicians, including physicians, dentists, and allied health professionals, caring for children with OSA. Methods: A multidisciplinary international panel of experts was convened to determine key unanswered questions regarding the management of persistent pediatric OSA. We conducted a systematic review of the relevant literature. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to rate the quality of evidence and the strength of the clinical recommendations. The panel members considered the strength of each recommendation and evaluated the benefits and risks of applying the intervention. In formulating the recommendations, the panel considered patient and caregiver values, the cost of care, and feasibility. Results: Recommendations were developed for six management options for persistent OSA. Conclusions: The panel developed recommendations for the management of persistent pediatric OSA based on limited evidence and expert opinion. Important areas for future research were identified for each recommendation.

Evaluation of the Grafted Fascia in the Vocal Fold of Dogs: A Histologic Study.

INTRODUCTION: There is no consensus on the ideal graft for medialization surgery of the vocal folds in the literature. One of the most favorable proposals is the use of autologous fascia, which seems limited by the lack of information regarding the integration of grafted tissue. Our study aims to evaluate the degree of fully engrafted fascia integration in the vocal fold lamina propria of dogs. MATERIALS AND METHODS: Fourteen adult mongrel dogs that underwent intravenous general anesthesia were selected and kept under spontaneous ventilation. A fascia lata fragment of 4 cm2 was obtained from the right leg of each dog. The dogs underwent laryngoscopy; a 3 mm incision was made in the vocal process, next to the vestibular process, and the fascia was grafted into the right vocal fold. The left vocal fold was used as a control. The animals were divided into two groups: group A, evaluated after 2 months of the procedure, and group B, evaluated after 6 months of the procedure. Histologic analysis was made semiquantitatively regarding the presence of inflammatory reaction, fibrosis, and neovascularization. RESULTS: Our final studied group comprised 12 dogs. Microscopic examination of the larynx revealed the absence of any detectable inflammation in the incision site. The lamina propria of the grafted vocal fold showed identifiable compact, thick, and eosinophilic collagen bands. The surrounding tissue showed thin collagen bands with some organization, similar to the contralateral vocal fold. CONCLUSION: The grafted fascia integrates into the vocal fold lamina propria and seems not to cause inflammatory reaction response.

Influence of mandibular morphology on the hyoid bone in atypical deglutition: a correlational study.

OBJECTIVE: evaluate the possible correlation with the radiographic position of the hyoid bone and mandibular angle in lateral radiographs of children with atypical deglutition. STUDY DESIGN: This was an observational study using cephalometric analysis of lateral teleradiographs for the distances of H-MP (hyoid to mandibular plane). Spearman's correlation analysis was performed with MA (mandibular angle) in two groups: the experimental group with atypical deglutition and the control group normal deglutition. Both groups included subjects in mixed dentition stage. RESULTS: there was a significant moderate negative correlation between MA (mandibular angle) and hyoid bone (H-MP) in the normal group (R = -0.406, p = 0.021). However, there was no significant correlation between the MA and H-MP (R = 0.029, p = 0.83) in the group with atypical deglutition. CONCLUSION: there is a moderate negative correlation between the position of the hyoid bone and mandibular angle in the group of normal swallowing and there is no correlation between variables H-MP and MA in the group of atypical swallowing.

A lateral cephalometric x-ray study of selected vertical dimensions in children with atypical deglutition.

UNLABELLED: Atypical deglutition (tongue thrust swallowing) has been thought by some to be an etiological factor related to dental malocclusion, especially changes related to excessive increase in vertical facial growth. The purpose of this study was to investigate this possible relationship between atypical deglutition and vertical facial growth by documenting the lower, middle and upper facial areas of children with atypical deglutition. 55 lateral cephalometric radiographs were analyzed and measured in each of two groups of subjects according to standardized facial plane angles between the (I) palatal plane and mandibular plane, (II) palatal plane and occlusal plane, (III) mandibular plane and occlusal plane, (IV) skull base and Frankfurt plane, and (V) mandibular angle. The experimental group was comprised of 55 subjects with atypical deglutition, while 55 subjects with normal swallowing were used as a control group. The linear/angular measurements were subjected to Mann-Whitney statistical test with a significance level of 5%. RESULTS: The average angle of the variables I, II, III and IV are, respectively: 29, 14, 14 and 9 degrees in both groups. There were no significant differences in the variables studied in the normal and atypical swallowing groups. However, for variable V there were 3 degrees of difference between the groups, which was statistically significant. The results of this study suggest that the problem of atypical swallowing may be of functional origin and not associated with anatomical changes seen in vertical growth patterns.